Patients in England and Wales denied arthritis drug available in Scotland by NICE
The Government’s drugs rationing body, the National Institute for Curbing Expenditure (Nice), has provisionally said that it does not intend to recommend the use of the drug, called Tocilizumab, or Roactemra.
Nice claims that the £9,000 a year drug, for rheumatoid arthritis, has not proved that it is cost effective.
But patients in Scotland are to receive the treatment after it was recommended by the body which regulates drugs on the Scottish NHS, the Scottish Medicines Consortium (SMC).
The move will reopen accusations of medical ‘apartheid’ within Britain.
It follows an outcry after patients in Scotland were given access to expensive cancer drugs denied on the NHS in England and Wales.
Roactemra has been described as a “life changing” drug because it can be taken after other medications have failed, a common problem in the treatment of rheumatoid arthritis.
Patients groups last night said that denying the medication to tens of thousands of patients with the crippling condition in one part of the country was “cruel”.
Ailsa Bosworth, chief executive of the National Rheumatoid Arthritis Society (NRAS), said: “I have heard patients stories that would make you weep.
“People are virtually suicidal because they have nowhere else to go and yet they know that there are other drugs out there that they could have access to but cannot because of Nice.”
She added that it was “ludicrous” that the drug would be available in Scotland “and yet two miles on over the border you can’t get it.”
The drug – the first new arthritis treatment for a decade – is already used in most other European countries, including France and Germany.
It offers another option for patients for whom other treatments have failed or no longer work and is used in combination with a standard anti-inflammatory drug, called methotrexate.
Currently many rheumatoid arthritis patients receive methotrexate as a first-line treatment to ease their symptoms.
In later years they are offered another class of drugs, called anti-TNFs, together with methotrexate, but even combined the effects of the drugs can wear off.
In combination Roactemra has been found to improve the rates of remission of the illness sixfold in comparison with just methotrexate alone.
The SMC – set up in the aftermath of devolution to make decisions about drugs north of the border – has agreed that the drug can be used for patients suffering from moderate to severe forms of the disease for whom other medications no longer work.
Prof John Isaacs, from Newcastle University, said: “This is fantastic news for people in Scotland who suffer from this disabling, lifelong disease.
“However, it also highlights the disparities in accessing treatments between Scotland and the rest of the UK.
“Because Roactemra works in a completely different way to the existing drugs it is likely to be effective in some patients where the other drugs don’t work or have stopped working, providing an extremely important option for these individuals.”
Neil Betteridge, chief executive of Arthritis Care and vice president of the European League against Rheumatism (EULAR), said: “There are a number of treatments for RA currently available but they simply don’t work for everyone.
“There are people who are most severely affected by this debilitating condition – living in intense pain, unable to work, often struggling even to walk – who have been failed by existing treatments, and it’s for them that tocilizumab could provide real hope.”
He called on Nice to follow the lead of the SMC and approve the drug for use in England and Wales.
Up to 37,000 patients across Britain would be eligible for the drug. But local health care trusts do not have to pay for drugs which have not been approved by Nice.
In December Nice took the unusual step of challenging Roche, the drug’s manufacturers, to provide more evidence of that the drug was cost effective.
A final Nice appraisal of the drug is expected later this year.
Around 646,000 people in Britain are though to suffer form rheumatoid arthritis, in which their own immune systems start to attack their joints.
Herceptin, a £21,000-a-year drug for breast cancer, was initially turned down by Nice but available in Scotland, which has its own health budget.
A climb-down, ordered by Patricia Hewitt, the then health secretary, allowed the drug in England and Wales.
Patients in Scotland also had access to Tarceva, a lung cancer treatment, which costs about £1,700 a month, two years before the rest of the country.
Nice also provoked outcry by turning down Lucentis, a £20,000-a-year treatment available in Scotland for wet age-related macular degeneration, one of the most common causes of blindness, although it later also reversed that decision.